College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China.
BMC Oral Health. 2024 Aug 22;24(1):973. doi: 10.1186/s12903-024-04737-1.
Patients with mild oral and maxillofacial space infection (OMSI) usually need only antimicrobial therapy. However, surgical intervention is eventually needed after using antibiotics for a period. The objective of this study was to explore the risk factors for drug therapy failure in OMSI.
A retrospective case‒control study was designed. From August 2020 to September 2022, patients at Shanghai Jiao Tong University Affiliated Ninth People's Hospital who were diagnosed with OMSI were retrospectively reviewed. The outcome variable was surgical intervention after the use of antibiotics. We collected common biological factors, including demographic characteristics, routine blood test results, C-reactive protein (CRP) levels and composite indicators, such as neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The χ2 test and binary logistic regression were used to examine the association between biological factors and the outcome variable.
Forty-six patients were included in this study. Further surgical intervention was needed in 20 patients (43.5%). The NLR showed a significant association with further surgical drainage (p = 0.01). A binary logistic regression equation was found by using stepwise regression based on the Akaike information criterion (R2 = 0.443), which was associated with sex (odds ratio [OR], 0.216; p = 0.092), NLR (OR, 1.258; p = 0.045), red blood cell (RBC) count (OR, 4.372; p = 0.103) and monocyte (MONO) count (OR, 9.528, p = 0.023). Receiver operating characteristic analysis produced an area under the curve for NLR of 0.725 (p = 0.01) and for the binary logistic regression model of 0.8365 (p < 0.001).
Surgical interventions are needed in some mild OMSI patients when antimicrobial therapy fails to stop the formation of abscesses. The binary logistic regression model shows that NLR can be used as an ideal prognostic factor to predict the outcome of antimicrobial therapy and the possibility of requiring surgical intervention.
Using simple, inexpensive, and easily achieved biological parameters (such as routine blood test results) and composite indicators calculated by them (such as NLR) to predict whether surgical intervention is needed in the future provides a reference for clinical doctors and enables more cost-effective and efficient diagnosis and treatment.
患有轻度口腔颌面部间隙感染（OMSI）的患者通常只需接受抗菌治疗。然而，在使用抗生素一段时间后，最终仍需要手术干预。本研究旨在探讨 OMSI 患者药物治疗失败的风险因素。
设计回顾性病例对照研究。本研究回顾性分析了 2020 年 8 月至 2022 年 9 月在上海交通大学附属第九人民医院诊断为 OMSI 的患者。结局变量为使用抗生素后进行手术干预。我们收集了常见的生物学因素，包括人口统计学特征、常规血液检查结果、C 反应蛋白（CRP）水平以及中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）等复合指标。采用 χ2检验和二项逻辑回归分析生物学因素与结局变量之间的关系。
本研究纳入了 46 例患者。其中 20 例（43.5%）需要进一步手术引流。NLR 与进一步手术引流有显著相关性（p=0.01）。根据赤池信息量准则（Akaike information criterion，AIC）采用逐步回归法建立了二项逻辑回归方程（R2=0.443），该方程与性别（比值比[OR]，0.216；p=0.092）、NLR（OR，1.258；p=0.045）、红细胞（RBC）计数（OR，4.372；p=0.103）和单核细胞（MONO）计数（OR，9.528，p=0.023）相关。NLR 的受试者工作特征曲线下面积为 0.725（p=0.01），二项逻辑回归模型的曲线下面积为 0.8365（p<0.001）。
在抗菌治疗未能阻止脓肿形成的情况下，一些轻度 OMSI 患者需要进行手术干预。二项逻辑回归模型表明，NLR 可用作预测抗菌治疗结局和是否需要手术干预的理想预后因素。
使用简单、廉价且易于获得的生物学参数（如常规血液检查结果）和通过它们计算得到的复合指标（如 NLR）来预测未来是否需要手术干预，可以为临床医生提供参考，从而实现更具成本效益和效率的诊断和治疗。
